Without some obstacles to the penetration of the transnational tobacco companies into the markets of the NIS, there is likely to be a major increase in tobacco use in the region over the next few years, leading to an increase in smoking-related diseases and deaths.
Tobacco advertising is one of the most important factors contributing to such a major increase in tobacco use (see Pierce, in this volume). The impact of tobacco advertising on the populations of the NIS, especially the younger generations, will be even stronger than would be expected in Western countries. This is because most of the NIS countries have been isolated and virtually unexposed to Western-type advertising for decades; the exception is the Baltic states, which have had greater access to Western European cultures. Using medical terminology, these states have not been "immunized" against tobacco advertising; therefore, they are particularly sensitive to it.
Another important issue is that throughout the Soviet era, Western-manufactured cigarettes not only were more socially acceptable than Soviet-made tobacco products, but also were highly attractive because, in a sense, they symbolized a desirable Western lifestyle. Now these products are widely available, and they are rapidly gaining popularity. The tobacco industry aggressively promotes the perceived "wealthy lifestyle with Western cigarettes" among youth by advertising and sponsoring popular events in ways that are familiar to all in the West. Most recently, ads in 1994 offered a lottery with a grand prize of a new sports utility vehicle (shown with three young adults clearly enjoying themselves), decorated with the cigarette company logo.
Measures to curb the further spread of tobacco advertising are urgently needed. These measures should take into account the extensive experience gained over the years in the West and the success of Western anti-smoking programs (see Pierce, in this volume). At the same time, they should also be specific to the region. It is important to remember that in terms of social norms and public awareness of smoking hazards, the NIS countries differ a great deal from Western countries.
During the recent Ninth World Conference on Tobacco and Health (Paris, October 10-14, 1994), a group of experts from Central and Eastern European countries outlined the priorities for tobacco control in the region. The NIS countries were represented by experts from Russia, Estonia, and Lithuania. The priorities identified are shown in Table 10-3. These priorities are based on detailed knowledge of the tobacco situation in each of the countries represented and comprise the basic needs for each regional anti-smoking campaign.